Girdauskas Evaldas, Rouman Mina, Disha Kushtrim, Espinoza Andres, Dubslaff Georg, Fey Beatrix, Theis Bernhard, Petersen Iver, Borger Michael A, Kuntze Thomas
Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany
Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany.
Eur J Cardiothorac Surg. 2016 Feb;49(2):635-43; discussion 643-4. doi: 10.1093/ejcts/ezv123. Epub 2015 Apr 7.
We prospectively examined functional characteristics of the aortic root and transvalvular haemodynamic flow in order to define factors associated with the severity of aortopathy in patients undergoing surgery for bicuspid aortic valve (BAV) stenosis.
A total of 103 consecutive patients with BAV stenosis (mean age 61 ± 9 years, 66% male) underwent aortic valve replacement ± concomitant aortic surgery from January 2012 through March 2014. All patients underwent preoperative cardiac magnetic resonance imaging (MRI) in order to evaluate the systolic transvalvular flow and the following functional parameters: (i) angulation between the left ventricular outflow axis and the aortic root, (ii) geometrical orientation of residual aortic valve orifice and (iii) BAV cusp fusion pattern. MRI data were used to guide sampling of the ascending aorta during surgery [i.e. jet-sample from the area where the flow-jet impacts on the aortic wall and control sample from the opposite aortic wall (obtained from the aortotomy site)]. Aortopathy was quantified by means of a histological sum-score (0 to 21+) in each sample.
A significant correlation was found between histological sum-score in the jet-sample and the angle between the LV outflow axis and the aortic root (r = 0.6, P = 0.007). Moreover, there was a linear correlation between proximal aortic diameter and the angle between systolic flow-jet and ascending aortic wall (r = 0.5, P = 0.006). Logistic regression identified the angle between the LV outflow axis and the aortic root (OR 1.1, P = 0.04) and the angle between the flow-jet and the aortic wall (OR 1.2, P = 0.001) as independent predictors of an indexed proximal aortic diameter ≥22 mm/m(2).
Functional parameters of the aortic root may be used to predict the severity of aortopathy in patients with BAV stenosis, and may be useful in predicting future risk of aortic disease in such patients.
我们前瞻性地研究了主动脉根部的功能特征和跨瓣血流动力学，以确定与二叶式主动脉瓣（BAV）狭窄手术患者主动脉病变严重程度相关的因素。
2012年1月至2014年3月，共有103例连续的BAV狭窄患者（平均年龄61±9岁，66%为男性）接受了主动脉瓣置换术及同期主动脉手术。所有患者术前行心脏磁共振成像（MRI），以评估收缩期跨瓣血流及以下功能参数：（i）左心室流出轴与主动脉根部之间的夹角；（ii）残余主动脉瓣口的几何方向；（iii）BAV瓣叶融合模式。MRI数据用于指导手术中升主动脉的取材[即从血流喷射撞击主动脉壁的区域取材（喷射样本），并从相对的主动脉壁（取自主动脉切开部位）取材作为对照样本]。通过每个样本的组织学总分（0至21+）对主动脉病变进行量化。
喷射样本的组织学总分与左心室流出轴和主动脉根部之间的夹角之间存在显著相关性（r = 0.6，P = 0.007）。此外，近端主动脉直径与收缩期血流喷射和升主动脉壁之间的夹角存在线性相关性（r = 0.5，P = 0.006）。逻辑回归分析确定左心室流出轴与主动脉根部之间的夹角（OR 1.1，P = 0.04）以及血流喷射与主动脉壁之间的夹角（OR 1.2，P = 0.001）是索引近端主动脉直径≥22 mm/m²的独立预测因素。
主动脉根部的功能参数可用于预测BAV狭窄患者主动脉病变的严重程度，并可能有助于预测此类患者未来发生主动脉疾病的风险。
